Provider Demographics
NPI:1609365436
Name:NGUYEN, LISA KHOA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:KHOA
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 E ONTARIO AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3620
Mailing Address - Country:US
Mailing Address - Phone:951-278-1645
Mailing Address - Fax:951-278-2127
Practice Address - Street 1:1290 E ONTARIO AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3620
Practice Address - Country:US
Practice Address - Phone:951-278-1645
Practice Address - Fax:951-278-2127
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH52715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist